WIC PROGRAM SHOULD PLACE STRONGER EMPHASIS ON THOSE MOST LIKELY TO BENEFIT

WASHINGTON -- A federally funded, state-run program that provides food, nutrition education, and health care referrals for mothers and young children could better address the unmet needs of poor children by targeting those most likely to benefit from improved nutrition, according to a new report* from a committee of the Institute of Medicine. The report recommends changes in the way mothers and children are selected for participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The committee recommended that the system for determining eligibility and setting priorities for assistance be tailored to reach those most likely to benefit from participation in the program -- a fundamental shift for the 20-year old, $3.8 billion program, which historically has selected individuals based solely on nutritional risk factors.

"The WIC program, in its present form, is very effective at identifying those at risk, but it could be made more effective by focusing greater attention to factors, such as homelessness, that make children vulnerable to nutrition problems," said committee chair Richard E. Behrman of the Center for the Future of Children, David and Lucile Packard Foundation, Los Altos, Calif. "Potential to benefit should be considered as strongly as the identification of risk, in order to maximize the impact of the program."

First established in 1974, WIC has grown to where it now assists more than 7 million low-income pregnant women and new mothers, infants, and children who are considered at nutrition risk. This risk is defined as either having the physical signs of poor nutrition and health or other nutritionally related medical conditions, dietary deficiencies that impair or endanger health, or circumstances that may lead one to poor nutrition.

SCIENTIFICALLY BASED ELIGIBILITY

The committee evaluated the science that supports WIC's "nutrition risk criteria," a comprehensive set of indicators and cutoff points used by individual states to screen applicants and establish eligibility. The report concludes that there is an adequate science base to support the use of the majority of the WIC criteria, but for some there are "serious gaps in the evidence." The report contains a comprehensive set of recommendations for changes in more than 80 individual criteria, to help the Food and Consumer Service of the U.S. Department of Agriculture guide states in determining who should be eligible for WIC participation.

The committee said that because eligibility cutoff points in some criteria are generous or conditions are poorly defined, many people who are not actually at risk may be selected for participation in the program. Anemia is used frequently in the WIC program to establish eligibility. But because some states use very high cutoff points for anemia, for example, an infant who is at little risk of the condition may receive WIC benefits while a young homeless child who is actually at greater risk may not. Federal regulation ranks risk criteria into seven priority levels, and cutoff points that appear to be set without scientific backing may result in the rejection of individuals who are actually at higher nutrition risk but in a lower priority level. The priority system dictates that those in higher categories be funded first, and individuals in low priority categories are placed on a waiting list if funding is exhausted.

SHIFTING PRIORITIES

In addition to assessing individual risk criteria and cutoff values, the report recommends a reassessment of the priority system. More attention should be given to whether an individual is insecure about his or her ability to obtain a nutritious meal regularly, for example, as well as to factors that may predispose one to poor nutrition, such as homelessness. Risk criteria for children that warrant inclusion in higher priority categories include nutrient deficiency diseases, malnutrition leading to a slow rate of growth, serious metabolic problems from birth, and gastrointestinal disorders. Criteria such as high caffeine intake, and maternal age older than 35, should be eliminated because of a lack of evidence about nutrition risk and benefit. And lower priority should be given to conditions such as mild nausea and vomiting during pregnancy, lack of prenatal care, and the use of cigarettes, alcohol or illegal drugs, a majority of the committee said. Three committee members preferred retaining high priority status for the criteria alcohol use and illegal drug use; and two of the three also preferred retaining high priority status for cigarette use.

New research is needed to identify or develop additional risk criteria for selecting individuals susceptible to health and nutrition problems, the report says. And with the needs of the population constantly in flux, the criteria in use should be evaluated every five to 10 years, and adjustments made as needed.

The study was funded by the U.S. Department of Agriculture. A committee roster follows. The Institute of Medicine is a private, non-profit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences.

*Copies of WIC Nutrition Risk Criteria: A Scientific Assessmentwill be available in late June from the National Academy Press at the mailing address in the letterhead; tel. (202) 334-3313 or 1-800-624-6242. Estimated cost of the report is $39.00 (prepaid) plus shipping charges of $4.00 for the first copy and $.50 for each additional copy. Reporters may obtain pre-publication copies from the Office of News and Public Information at the letterhead address (contacts listed above).

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